Method for implanting soft tissue

ABSTRACT

A suture construction and method for forming a suture construction is disclosed. The construction utilizes a suture having an enlarged central body portion defining a longitudinal passage. First and second ends of the suture are passed through first and second apertures associated with the longitudinal passage to form a pair of loops. Portions of the suture lay parallel to each other within the suture. Application of tension onto the suture construction causes constriction of the longitudinal passage, thus preventing relative motions of the captured portions of the suture.

FIELD

The present disclosure relates to suture loop constructions and, moreparticularly, to a locking suture loop construction and a method of itsconstruction.

BACKGROUND

The statements in this section merely provide background informationrelated to the present disclosure and may not constitute prior art.

It is commonplace in arthroscopic procedures to employ sutures andanchors to secure soft tissues to bone. Despite their widespread use,several improvements in the use of sutures and suture anchors can bemade. For example, the procedure of tying knots can be very timeconsuming, thereby increasing the cost of the procedure and limiting thecapacity of the surgeon. Furthermore, the strength of the repair may belimited by the strength of the knot. This latter drawback may be ofparticular significance if the knot is tied improperly as the strengthof the knot in such situations can be significantly lower than thetensile strength of the suture material.

To overcome this problem, sutures having a single preformed loop havebeen provided. FIG. 1 represents a prior art suture construction. Asshown, one end of the suture is passed through a passage defined in thesuture itself. The application of tension to the ends of the suturepulls a portion of the suture through the passage, causing a loop formedin the suture to close. Unfortunately, relaxation of the system canallow a portion of the suture to translate back through the passage,thus relieving the desired tension.

It is an object of the present teachings to provide an alternativedevice for anchoring sutures to bone and soft tissue. The device, whichis relatively simple in design and structure, is highly effective forits intended purpose.

SUMMARY

To overcome the aforementioned deficiencies, a method for configuring abraided tubular suture and a suture configuration are disclosed. Themethod includes passing a first end of the suture through a firstaperture into a passage defined by the suture and out a second aperturedefined by the suture so as to place the first end outside of thepassage. A second end of the suture is passed through the secondaperture into the passage and out the first aperture so as to place thesecond end outside of the passage.

In another embodiment, a method for configuring a braided suture isdisclosed. The method includes passing a first end of the suture throughthe first aperture defined between the pair of fibers defining thesuture and into a longitudinal passage defined by the suture. The firstend of the suture is then passed through a second aperture definedbetween a second pair of fibers so as to place the first end outside ofthe longitudinal passage. A second end of the suture is passed through athird aperture defined between a third pair of fibers and into thelongitudinal passage. The second end is passed through an aperturedefined by a fourth pair of fibers so as to place the second end outsideof the longitudinal passage.

In another embodiment, a suture anchor construction is providedcomprising a suture and a suture anchor defining a bore. The suture hasfirst and second ends and defines an interior longitudinal passageportion, and first and second depending apertures disposed between thefirst and second ends. The first end is placed through the first andsecond apertures so as to place a first portion within the longitudinalpassage portion, and the second end is placed through the second andfirst aperture so as to place a second portion within a first portion ofthe longitudinal passage portion. The first portion is at leastpartially disposed with the bore. The suture anchor can be one of ascrew, a plate, and a cannulated member.

In another embodiment, a suture construction is provided having a suturewith first and second ends and an enlarged central portion defining aninterior longitudinal passage. First and second passage dependingapertures are disposed between the first and second ends. The first endbeing placed through the first and second apertures so as to place afirst portion of the suture within the longitudinal passage. The secondend being placed through the second and first aperture so as to place asecond portion of the suture within the longitudinal passage.

Further areas of applicability will become apparent from the descriptionprovided herein. It should be understood that the description andspecific examples are intended for purposes of illustration only and arenot intended to limit the scope of the present disclosure.

DRAWINGS

The drawings described herein are for illustration purposes only and arenot intended to limit the scope of the present disclosure in any way.

FIG. 1 represents a prior art suture configuration;

FIGS. 2A and 2B represent suture constructions according to theteachings;

FIG. 3 represents the formation of the suture configuration shown inFIG. 2A;

FIGS. 4A and 4B represent alternate suture configurations;

FIGS. 5-7 represent further alternate suture configurations;

FIG. 8 represents the suture construction according to FIG. 5 coupled toa bone engaging fastener;

FIGS. 9, 10, 11A, and 11B represent the coupling of the sutureconstruction according to FIG. 5 to a bone screw;

FIGS. 12A-12E represent the coupling of a soft tissue to an ACLreplacement in a femoral/humeral reconstruction; and

FIGS. 13A-13D represent a close-up view of the suture shown in FIGS.1-11C.

DETAILED DESCRIPTION

The following description is merely exemplary in nature and is notintended to limit the present disclosure, application, or uses. Itshould be understood that throughout the drawings, correspondingreference numerals indicate like or corresponding parts and features.

FIG. 2A represents a suture construction 20 according to the presentteachings. Shown is a suture 22 having a first end 24 and a second end26. The suture 22 is formed of a braided body 28 that defines alongitudinally formed hollow passage 30 therein. First and secondapertures 32 and 34 are defined in the braided body 28 at first andsecond locations of the longitudinally formed passage 30.

Briefly referring to FIG. 3, a first end 24 of the suture 22 is passedthrough the first aperture 32 and through longitudinal passage 30 formedby a passage portion, and out the second aperture 34. The second end 26is passed through the second aperture 34, through the passage 30 and outthe first aperture 32. This forms two loops 46 and 46′. As seen in FIG.28, the relationship of the first and second apertures 32 and 34 withrespect to the first and second ends 24 and 26 can be modified so as toallow a bow-tie suture construction 36. As described below, thelongitudinal and parallel placement of first and second suture portions38 and 40 of the suture 22 within the longitudinal passage 30 resiststhe reverse relative movement of the first and second portions 38 and 40of the suture once it is tightened.

The first and second apertures are formed during the braiding process asloose portions between pairs of fibers defining the suture. As furtherdescribed below, the first and second ends 24 and 26 can be passedthrough the longitudinal passage 30 multiple times. It is envisionedthat either a single or multiple apertures can be formed at the ends ofthe longitudinally formed passage.

As best seen in FIGS. 4A and 4B, a portion of the braided body 28 of thesuture defining the longitudinal passage 30 can be braided so as to havea diameter larger than the diameter of the first and second ends 24 and26. Additionally shown are first through fourth apertures 32, 34, 42,and 44. These apertures can be formed in the braiding process or can beformed during the construction process. In this regard, the apertures32, 34, 42, and 44 are defined between adjacent fibers in the braidedbody 28. As shown in FIG. 4B, and described below, it is envisioned thesutures can be passed through other biomedically compatible structures.

FIGS. 5-7 represent alternate constructions wherein a plurality of loops46 a-d are formed by passing the first and second ends 24 and 26 throughthe longitudinal passage 30 multiple times. The first and second ends 24and 26 can be passed through multiple or single apertures defined at theends of the longitudinal passage 30. The tensioning of the ends 24 and26 cause relative translation of the sides of the suture with respect toeach other.

Upon applying tension to the first and second ends 24 and 26 of thesuture 22, the size of the loops 46 a-d is reduced to a desired size orload. At this point, additional tension causes the body of the suturedefining the longitudinal passage 30 to constrict about the parallelportions of the suture within the longitudinal passage 30. Thisconstriction reduces the diameter of the longitudinal passage 30, thusforming a mechanical interface between the exterior surfaces of thefirst and second parallel portions as well as the interior surface ofthe longitudinal passage 30.

As seen in FIGS. 8-11, the suture construction can be coupled to variousbiocompatible hardware. In this regard, the suture construction 20 canbe coupled to an aperture 52 of the bone engaging fastener 54.Additionally, it is envisioned that soft tissue or bone engaging members56 can be fastened to one or two loops 46. After fixing the boneengaging fastener 54, the members 56 can be used to repair, forinstance, a meniscal tear. The first and second ends 24, 26 are thenpulled, setting the tension on the loops 46, thus pulling the meniscusinto place. Additionally, upon application of tension, the longitudinalpassage 30 is constricted, thus preventing the relaxation of the tensioncaused by relative movement of the first and second parallel portions38, 40, within the longitudinal passage 30.

As seen in FIGS. 9-11B, the loops 46 can be used to fasten the sutureconstruction 20 to multiple types of prosthetic devices. As describedfurther below, the suture 22 can further be used to repair and couplesoft tissues in an anatomically desired position. Further, retraction ofthe first and second ends allows a physician to adjust the tension onthe loops between the prosthetic devices.

FIG. 11b represents the coupling of the suture construction according toFIG. 28 with a bone fastening member. Coupled to a pair of loops 46 and46′ are tissue fastening members 56. The application of tension toeither the first or second end 24 or 26 will tighten the loops 46 or 46′separately.

FIGS. 12A-12E represent potential uses of the suture constructions 20 inFIGS. 2A-7 in an ACL repair. As can be seen in FIG. 12A, thelongitudinal passage portion 30 of suture construction 20 can be firstcoupled to a fixation member 60. The member 60 can have a first profilewhich allows insertion of the member 60 through the tunnel and a secondprofile which allows engagement with a positive locking surface uponrotation. The longitudinal passage portion 30 of the suture construction20, member 60, loops 46 and ends 24, 26 can then be passed through afemoral and tibial tunnel 62. The fixation member 60 is positioned orcoupled to the femur. At this point, a natural or artificial ACL 64 canbe passed through a loop or loops 46 formed in the suture construction20. Tensioning of the first and second ends 24 and 26 applies tension tothe loops 46, thus pulling the ACL 64 into the tunnel. In this regard,the first and second ends are pulled through the femoral and tibialtunnel, thus constricting the loops 46 about the ACL 64 (see FIG. 12B).

As shown, the suture construction 20 allows for the application of forcealong an axis 61 defining the femoral tunnel. Specifically, theorientation of the suture construction 20 and, more specifically, theorientation of the longitudinal passage portion 30, the loops 46, andends 24, 26 allow for tension to be applied to the construction 20without applying non-seating forces to the fixation member 60. As anexample, should the loops 24, 26 be positioned at the member 60,application of forces to the ends 24, 26 may reduce the seating forceapplied by the member 60 onto the bone.

As best seen in FIG. 12C, the body portion 28 and parallel portions 38,40 of the suture construction 20 remain disposed within to the fixationmember 60. Further tension of the first ends draws the ACL 64 up throughthe tibial component into the femoral component. In this way, sutureends can be used to apply appropriate tension onto the ACL 64 component.The ACL 64 is then fixed to the tibial component using a plug or screwas is known.

After feeding the ACL 64 through the loops 46, tensioning of the endsallows engagement of the ACL with bearing surfaces defined on the loops.The tensioning pulls the ACL 64 through a femoral and tibial tunnel. TheACL 64 could be further coupled to the femur using a transverse pin orplug. As shown in FIG. 12E, once the ACL is fastened to the tibia,further tensioning can be applied to the first and second ends 24, 26placing a desired predetermined load on the ACL. This tension can bemeasured using a force gauge. This load is maintained by the sutureconfiguration. It is equally envisioned that the fixation member 60 canbe placed on the tibial component 66 and the ACL pulled into the tunnelthrough the femur. Further, it is envisioned that bone cement orbiological materials may be inserted into the tunnel 62.

FIGS. 13A-13D represent a close-up of a portion of the suture 20. As canbe seen, the portion of the suture defining the longitudinal passage 30has a diameter d₁ which is larger than the diameter d₂ of the ends 24and 26. The first aperture 32 is formed between a pair of fiber members.As can be seen, the apertures 32, 34 can be formed between two adjacentfiber pairs 68, 70. Further, various shapes can be braided onto asurface of the longitudinal passage 30.

The sutures are typically braided of from 8 to 16 fibers. These fibersare made of nylon or other biocompatible material. It is envisioned thatthe suture 22 can be formed of multiple type of biocompatible fibershaving multiple coefficients of friction or size. Further, the braidingcan be accomplished so that different portions of the exterior surfaceof the suture can have different coefficients of friction or mechanicalproperties. The placement of a carrier fiber having a particular surfaceproperty can be modified along the length of the suture so as to placeit at varying locations within the braided constructions.

The description of the invention is merely exemplary in nature and,thus, variations that do not depart from the gist of the invention areintended to be within the scope of the invention. Such variations arenot to be regarded as a departure from the spirit and scope of theinvention.

What is claimed is:
 1. A bone treatment apparatus, comprising: anadjustable suture construct including a suture with a first free end anda second free end, the first free end extending through a firstlongitudinal passage in the suture to form a first adjustable loop, thesecond free end extending through a second longitudinal passage in thesuture to form a second adjustable loop, wherein, with the first freeend extending through the first longitudinal passage in the suture toform the first adjustable loop and with the second free end extendingthrough the second longitudinal passage in the suture to form the secondadjustable loop, the first free end can be pulled through the firstlongitudinal passage to decrease a size of the first adjustable loop andthe second free end can be pulled through the second longitudinalpassage to decrease a size of the second adjustable loop, the firstlongitudinal passage being separate from the second longitudinal passagein the suture; an elongate bone engaging fastener with exterior threads,the adjustable suture construct coupled to the elongate bone engagingfastener; and a fixation member coupled to the adjustable sutureconstruct.
 2. The bone treatment apparatus of claim 1, wherein theadjustable suture construct extends down into the elongate bone engagingfastener.
 3. The bone treatment apparatus of claim 2, wherein theadjustable suture construct extends down into the elongate bone engagingfastener through an opening in a trailing end of the elongate boneengaging fastener.
 4. The bone treatment apparatus of claim 3, whereinat least a portion of the first adjustable loop and at least a portionof the second adjustable loop protrude from the opening in the trailingend of the elongate bone engaging fastener.
 5. A bone treatmentapparatus, comprising: an adjustable suture construct including a suturewith a first free end and a second free end, the first free endextending through a first aperture in the suture, along a firstlongitudinal passage in the suture, and out a fourth aperture in thesuture to form a first adjustable loop, the second free end extendingthrough a second aperture in the suture, along a second longitudinalpassage in the suture, and out a third aperture in the suture to form asecond adjustable loop, wherein the first aperture, the second aperture,the third aperture, and the fourth aperture are all separate aperturesin the suture, wherein, with the first free end extending through thefirst aperture in the suture, along the first longitudinal passage inthe suture, and out the fourth aperture in the suture to form the firstadjustable loop and with the second free end extending through thesecond aperture in the suture, along the second longitudinal passage inthe suture, and out the third aperture in the suture to form the secondadjustable loop, the first free end can be pulled through the firstlongitudinal passage to decrease a size of the first adjustable loop andthe second free end can be pulled through the second longitudinalpassage to decrease a size of the second adjustable loop; an elongatebone engaging fastener with exterior threads, the adjustable sutureconstruct coupled to the elongate bone engaging fastener; and a fixationmember coupled to the adjustable suture construct.
 6. The bone treatmentapparatus of claim 5, wherein the suture comprises a braided body. 7.The bone treatment apparatus of claim 6, wherein the braided body isbraided from 8 to 16 fibers.
 8. The bone treatment apparatus of claim 5,wherein the adjustable suture construct extends down into the elongatebone engaging fastener.
 9. The bone treatment apparatus of claim 8,wherein the adjustable suture construct extends down into the elongatebone engaging fastener through an opening in a trailing end of theelongate bone engaging fastener.
 10. The bone treatment apparatus ofclaim 9, wherein at least a portion of the first adjustable loop and atleast a portion of the second adjustable loop protrude from the openingin the trailing end of the elongate bone engaging fastener.
 11. The bonetreatment apparatus of claim 5, wherein the first longitudinal passageis separate from the second longitudinal passage in the suture.
 12. Abone treatment apparatus, comprising: an adjustable suture constructincluding a suture with a first free end and a second free end, thefirst free end extending into the suture through a first aperture in thesuture, longitudinally within the suture, and out of the suture througha fourth aperture in the suture to form a first adjustable loop, thesecond free end extending into the suture through a second aperture inthe suture, longitudinally within the suture, and out of the suturethrough a third aperture in the suture to form a second adjustable loop,wherein the first aperture, the second aperture, the third aperture, andthe fourth aperture are all separate apertures in the suture, wherein,with the first free end extending into the suture through the firstaperture in the suture, longitudinally within the suture, and out of thesuture through the fourth aperture in the suture to form the firstadjustable loop and with the second free end extending into the suturethrough the second aperture in the suture, longitudinally within thesuture, and out of the suture through the third aperture in the sutureto form the second adjustable loop, the first free end can be pulledthrough the first aperture and the fourth aperture in the suture todecrease a size of the first adjustable loop and the second free end canbe pulled through the second aperture and the third aperture in thesuture to decrease a size of the second adjustable loop; an elongatebone engaging fastener with exterior threads, the adjustable sutureconstruct coupled to the elongate bone engaging fastener; and a fixationmember coupled to the adjustable suture construct.
 13. The bonetreatment apparatus of claim 12, wherein the suture comprises a braidedbody.
 14. The bone treatment apparatus of claim 13, wherein the braidedbody is braided from 8 to 16 fibers.
 15. The bone treatment apparatus ofclaim 12, wherein the first free end and the second free end are spacedapart from one another while extending longitudinally within the suture.16. The bone treatment apparatus of claim 12, wherein the first free endand the second free end overlap one another while extendinglongitudinally within the suture.
 17. The bone treatment apparatus ofclaim 12, wherein the adjustable suture construct extends down into theelongate bone engaging fastener.
 18. The bone treatment apparatus ofclaim 17, wherein the adjustable suture construct extends down into theelongate bone engaging fastener through an opening in a trailing end ofthe elongate bone engaging fastener.
 19. The bone treatment apparatus ofclaim 18, wherein at least a portion of the first adjustable loop and atleast a portion of the second adjustable loop protrude from the openingin the trailing end of the elongate bone engaging fastener.